Job Description
As part the Mount Sinai Pharmacy team and on behalf of Mount Sinai Human Resources partners, the Pharmacy Benefits Program Director is responsible to provide service support, reporting, pricing, and/or other performance guarantees while working with multiple internal stakeholders and other external vendors. The Pharmacy Benefits Program Director serves as the primary pharmacy benefits subject matter expert supporting Mount Sinai Health System.
Qualifications
Registered Pharmacist required with active licensure in a US state or territory; advanced degree a plus.
Previous experience in developing clinical programs related to Formulary and Utilization management required.
Minimum of 6 years experience in the healthcare industry, with focus on Pharmacy Health Plan or Pharmacy Benefit Management.
Proven capabilities in strategic planning and large-scale project management.
Demonstrated ability to think/act strategically from a program value perspective and influence key leaders and matrix partners.
Demonstrated ability to work in a highly matrixed environment.
Strong communication and facilitation skills with all levels of the organization, including ability to resolve issues and build consensus among groups of diverse internal/external stakeholders.
Experience with consultative client management methodologies.
A self motivated individual displaying ownership, accountability, and responsibility.
Ability to work through organizational processes needed to support clients.
Operational understanding and competence with PBM business models.
Understanding of the financial and pricing strategies of PBM’s.
Technical skills suing all Microsoft programs
Competencies
Compensation Statement
The Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for this role is $153,723.00 - $230,584.00 Annually. Actual salaries depend on a variety of factors, including experience, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.
, 600 - HSO Pharmacy - MSH, Mount Sinai Hospital
Responsibilities
Work with internal stakeholders to maintain the commercial formulary change process, evaluating pharmacy and medical drug strategy opportunities and formulary product enhancements to drive pharmacy affordability to Mount Sinai Health System.
Responsible for the development of complex utilization management strategies and drug utilization review programs to enhance formulary strategies and improve clinical outcomes in alignment with the clinical determination of the Pharmacy and Therapeutics Committee.
Ensures the clinical integrity of the Health Plan pharmacy offering.
Partners with Health Plan Supply Chain to evaluate and deploy available service solutions that meet Health Plan clinical and affordability goals.
Develops differentiated prescription drug benefit affordability capabilities that meet the unique needs of the buying groups and funding types within the Health Plan book of business.
Responsible for ensuring downstream implementation processes are efficient and support the continuous development of business strategies.
Ensure regulatory compliance by reviewing new state mandates and updating internal processes to support adherence.
Provides clinical and contextual insights to partners within the Health Plan finance, underwriting, and risk-bearing products to ensure that emerging therapeutics and revisions to the US drug supply are accurately reflected in financial projections (trend, underwriting, and pricing).
Partner with the Health Plan Medical organization to support discussions with professional societies about complex and/or controversial formulary changes where engagement with external organizations is needed.
Creates a sense of purpose/meaning for the team that aligns with Mount Sinai values and mission.
Supports and promotes appropriate team alignment and process improvement work.
Provides coaching and development to teams, in particular, direct reports for succession planning and overall career growth.
Participate in meetings and presentations to review benefits management performance.
Act as pharmacy representation for renewals involving consultants.
Collaborate with Mount Sinai Health System Payer Contracting leadership with contracting proposals and growing existing relationships.
Gather and share relevant competitive intelligence to promote clinical programs and savings strategies.
Remain abreast of clinical pharmacy practice guidelines, including drug pipelines, bio-similars, gene therapies, and patent expirations, etc.
Facilitate meetings with PBM to resolve customer service issues and act as the escalated issue contact for pharmacy matters.
Support detailed ad hoc analysis of pharmacy claims utilization in order to provide clients with consultation and manage follow up questions as they arise.
Educate and consistently advance the knowledge of pharmacy within Mount Sinai Health System and champion the understanding of clinical integration points across benefits.
Fosters an effective work environment and ensures employees receive appropriate communication, recognition and development.
Any other tasks as assigned by management.
About Us
Strength Through Diversity
The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education, and advancement as we revolutionize medicine together. We invite you to participate actively as a part of the Mount Sinai Health System team by:
Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential.
Serving as a role model confronting racist, sexist, or other inappropriate actions by speaking up, challenging exclusionary organizational practices, and standing side-by-side in support of colleagues who experience discrimination.
Inspiring and fostering an environment of anti-racist behaviors among and between departments and co-workers.
At Mount Sinai, our leaders strive to learn, empower others, and embrace change to further advance equity and improve the well-being of staff, patients, and the organization. We expect our leaders to embrace anti-racism, create a collaborative and respectful environment, and constructively disrupt the status quo to improve the system and enhance care for our patients. We work hard to create an inclusive, welcoming and nurturing work environment where all feel they are valued, belong and are able to advance professionally.
Explore more about this opportunity and how you can help us write a new chapter in our history!
“About the Mount Sinai Health System:
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,400 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 14 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.
The Mount Sinai Health System is an equal opportunity employer. We comply with applicable Federal civil rights laws and does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, or gender expression. We are passionately committed to addressing racism and its effects on our faculty, staff, students, trainees, patients, visitors, and the communities we serve. Our goal is for Mount Sinai to become an anti-racist health care and learning institution that intentionally addresses structural racism.”
EOE Minorities/Women/Disabled/Veterans
Compensation Statement
Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $153723 - $230584 Annually. Actual salaries depend on a variety of factors, including experience, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.
